Most classifications of movement disorders emphasize their differential diagnosis and epidemiology according to clinical history and neurological examination. This review of movement disorders is organized according to the hypothesis of basal ganglia neurotransmitter imbalance in order to emphasize current research based on the pharmacology of these disorders. Specifically, dopamine (DA) excess and acetylcholine (ACh) deficiency may characterize part of the pathology of several hyperkinetic movement disorders including tardive dyskinesia, Huntington disease, Gilles de la Tourette syndrome, l-dopa dyskinesias, tardive Tourette syndrome, and toxic Tourette syndrome. The mirror image of this paradigm, namely DA deficiency and ACh excess, may characterize several rigid-dystonic movement disorders including Parkinson disease, drug-induced dystonias, and dystonia musculorum deformans. Finally, the unique combination of DA excess with ACh excess may characterize idiopathic orofacial dyskinesia (also known as Meige dystonia, Brueghel syndrome, and blepharospasm-oromandibular dystonia). Evidence supporting this formulation of movement disorders is reviewed, the limitations of this hypothesis are discussed, and new data from our own studies are presented.

译文

:根据临床病史和神经系统检查,大多数运动障碍分类都强调其鉴别诊断和流行病学。根据基础神经节神经递质失衡的假说来组织对运动障碍的研究,以强调基于这些疾病的药理学的当前研究。具体来说,多巴胺(DA)过量和乙酰胆碱(ACh)缺乏可能是几种运动亢进性运动障碍的一部分病理特征,包括迟发性运动障碍,亨廷顿病,吉尔斯·德·图雷特综合症,左旋多巴运动障碍,迟发性图雷特综合症和毒性图雷特综合症。这种范例的镜像,即DA缺乏和ACh过量,可能是几种刚性肌张力障碍运动障碍的特征,包括帕金森病,药物引起的肌张力障碍和变形肌张力障碍。最后,DA过量与ACh过量的独特结合可能是特发性口面肌运动障碍(也称为Meige肌张力障碍,Brueghel综合征和睑睑痉挛-眶下肌张力障碍)。审查支持这种运动障碍的表述的证据,讨论了这一假设的局限性,并提出了来自我们自己研究的新数据。

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